Stroke

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REVIEW our Selected Stroke Articles in 2006. Stay informed and updated!

Stroke

NIH - Medical Encyclopedia: Stroke

"The goal is to get the person to the emergency room immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy -- all within 3 hours of when the stroke began."

Highlighted Article

Transient Ischemic Attack: A Dangerous Harbinger and an Opportunity to Intervene. (Semin Neurol. 2005)

"Transient ischemic attack (TIA) and ischemic stroke are both characterized by sudden onset of neurological symptoms due to focal cerebral ischemia, but they are distinguished by the duration of neurological symptoms, with TIA traditionally defined by resolution of symptoms within 24 hours and stroke reserved for symptoms of longer duration. ... The short-term risk of ischemic stroke after TIA is very high ..."

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Stroke

Diagnosis, Imaging, and Screening

NEWS:

CT scans in ERs catch only 25 percent of strokes: MRIs detect 80 percent and should be new standard of care, doctors advise "The most common method of diagnosing a stroke in the emergency rooms catches only about one out of every four cases — far fewer than an MRI scan, which also was better at spotting the type of stroke, a U.S. government funded study showed. The study led some experts, writing in the medical journal The Lancet, to declare that MRI scans should replace CT X-rays as the standard of care."

Having a stroke? Make 911 your first call "People who think they're having a stroke, and their loved ones, often call others for advice before calling an ambulance, hints a study conducted in Australia. This could lead to delays in the administration of potentially life-saving treatment. Half of stroke patients or the people with them at the time of the stroke consulted a third-party, who frequently came to the patient's home before calling an ambulance, Dr. Ian Mosley of the National Stroke Research Institute in Heidelberg Heights, Victoria and colleagues report."

MRI More Sensitive than CT in Diagnosing Stroke

Report from International Stroke Conference: MRI outperforms CT for initial stroke evaluation "A multicenter prospective trial involving 1210 patients in Europe has found that the odds of a favorable clinical outcome were one-third higher for acute stroke patients who received diffusion-perfusion MRI to determine the appropriateness of tPA thrombolysis than patients assessed with conventional noncontrast CT."

Transient ischemic attacks can be rapidly detected "The initial emergency department evaluation included a history and physical, an ECG, cardiac monitoring, a panel of lab tests, and a head CT. Patients also underwent imaging of the neck arteries, 2-dimensional echocardiography, serial nursing "neurochecks," and a neurology consultation. Most patients (85 percent) randomly assigned to the accelerated diagnostic protocol were discharged from the emergency department, the authors report, and the average length of stay was significantly shorter for the accelerated diagnostic protocol patients (25.6 hours) than for patients admitted to hospital (61.2 hours). "

ARTICLES:

JOURNAL ARTICLES:

Can the ABCD Score be dichotomised to identify high-risk patients with transient ischaemic attack in the emergency department? (Emerg Med J. 2007) " CONCLUSION: In this retrospective analysis, dichotomising the ABCD Score was overinclusive but highly predictive in identifying patients with TIA at a high short-term risk of stroke. Use of the ABCD Score in the emergency care of patients with TIA is simple, efficient and provides a unique opportunity to prevent stroke in this population of patients."

Pitfalls in the diagnosis of cerebellar infarction. (Acad Emerg Med. 2007) "CONCLUSIONS: This study demonstrates how the diagnosis of cerebellar infarction can be missed or delayed in patients presenting to the emergency department."

Misdiagnosis of stroke. (Expert Rev Neurother. 2007) "Common presenting symptoms are limb weakness, and speech and visual disturbances. Common stroke mimics are seizures, space occupying lesions, syncope, somatization and delirium secondary to sepsis."

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